Frequency analysis of symptomatic worsening following ketamine infusions for treatment resistant depression in a real-world sample: Results from the canadian rapid treatment center of excellence.

Abstract

Antidepressants are associated with symptomatic worsening in a subgroup of patients. Replicated evidence has demonstrated rapid and robust antidepressant effects with intravenous (IV) ketamine in treatment resistant depression (TRD); however, the risk of ketamine worsening depressive symptoms in a subgroup of patients remains unknown. Herein we report a retrospective analysis on the rates of symptomatic worsening during an acute course of IV ketamine in individuals with unipolar (n = 142) and bipolar (n = 22) TRD. Adults (N = 164; mean age = 45.97) with TRD underwent four sub-anesthetic infusions (0.5-0.75 mg/kg over 40 min) of IV ketamine over two weeks, and were assessed with the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) at baseline and after each infusion. The primary outcome was the proportion of patients experiencing clinically significant worsening of depressive symptoms (≥20% increase on the QIDS-SR16) at each time point relative to baseline. Secondary analyses explored trends in the results. The frequency of clinically significant worsening fluctuated between 1.83% to 5.49%, with no identifiable trend across time. Zero individuals with bipolar TRD reported symptomatic worsening. Limitations include the single-centered, uncontrolled, retrospective nature of this study. Rates of symptomatic worsening associated with IV ketamine therapy for TRD appear to be very low and similar to conventional antidepressants.

• Authors: Joshua D Di Vincenzo, Orly Lipsitz, Nelson B Rodrigues, Brett D M Jones, Hartej Gill, Yena Lee, Leanna M W Lui, Kayla M Teopiz, Roger Ho, Kangguang Lin, Flora Nasri, Roger S McIntyre, Joshua D Rosenblat
• Journal: Psychiatry research (Psychiatry Res) Vol. 307 Pg. 114321 (01 2022) ISSN: 1872-7123 [Electronic] Ireland
• PMID: 34890909 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier B.V. All rights reserved.

Chemical References

• Ketamine

Topics

• Adult
• Canada (epidemiology)
• Depressive Disorder, Major (drug therapy)
• Depressive Disorder, Treatment-Resistant (drug therapy)
• Humans
• Infusions, Intravenous
• Ketamine (adverse effects)
• Middle Aged
• Retrospective Studies